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HTE# 09-- .j--23y`t�t� Harnett County Department of Public Health 2 3 1 1 8
PERMIT Operation Permit
ZNew Installation 2" Septic Tank R Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: <-Q at kw Xj
Name: (owner) or. a -N�a,, 8®,,,,�a„ SUBDIVISION C=,.-f �e LOT # -.Z
System Installer: Gaaay Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community L.7- Public ❑ Well Distance from well feet
System Type: G' Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
this system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and al a mp ovement Permit and Construction Authorization.
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PERMIT rmmnlTlnN(.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the seewwa disposal system on the above captioned property.
Type of system: ❑ Conventional Lit Other`" —V- i �G(c 41; Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 23 ® feet ditches —_ feet ditches inrhnc
French Drain Required: Linear feet
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Authorized State Agen ,PC1�1 Date �/Zz��a /f{
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